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Occupational science:
A renaissance of service to
humankind through knowledge
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colleagues from all over the planet who have joined in our adventure. We
search for new ideas which can contribute to a renaissance of service to
humankind by an occupational therapy profession which defines itself through
knowledge while being true to its values and traditions.
The journey begins with the context of the birth of occupational science.
What local and global conditions fostered the search for such a powerful set of
ideas? Then, how did our version of occupational science develop at the University of Southern California? What are some of the important ideas which
seem fruitful for investigation by occupational scientists in the year 2000?
And finally, what implications might occupational science hold for our profession as we enter a new millennium?
The context
Occupational science, the study of the human as an occupational being,
turned out to be a set of ideas whose time had come. On a global level it was
stimulated by such trends as: (1) the increasing population of people with
chronic impairments which impeded their participation in the daily life of
their culture (Guerrero et al., 1999); (2) public policy debates about both the
needs and rights of such people, including their desire for equality of capability
(Bickenbach, 1993); (3) the decreasing role of governments in providing
material resources for people with handicaps, with cost-curtailing attempts to
circumscribe the practice of all health professions; (4) cutting-edge new
approaches for the study of acting human beings in real-life contexts
(Csikszentmihalyi and Larson, 1984; Lincoln and Guba, 1985); (5) the mindboggling growth in the complexity of daily life with resultant problems in
organizing and using ones time, orchestrating ones activities, balancing roles
and achieving competence and satisfaction through occupation (Hochschild,
1997); and (6) a readiness for occupational therapists to leap into the
unknown waters of concepts and ideas because of the worldwide maturation of
our profession. This latter growth was inspired by the twin forces of the global
move of occupational therapy education away from technical schools into
universities, with increasing emphasis on ideas and postgraduate study, and
growing excitement and pride about occupational therapy practice and its
potential to serve humankind (Mounter and Ilott, 1997). For example, our
profession could advocate a new idea of health that would not exclude people
with chronic impairments (Pfeiffer, 1999). This contribution would require
that occupational therapy define its own knowledge base and from that create
its own definition and scope of practice.
People with disabling conditions are often categorized as sick by traditional
definitions of health even though they participate in the daily routines of their
culture. They are not ill but simply have impairments as most humans do at
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such engagement we need to ascertain how the biological, psychological, cultural and symbolic-spiritual levels of people contribute to and are affected by
their occupations. For example, play is an occupation requiring a biological
unfolding for its spontaneity, which contributes to significant learning
through exploration, develops a sense of agency, creates the ability to assume
appropriate social roles (Vygotsky, 1978) and offers exposure to the rituals of
ones culture, with rules and symbolic meanings. Play also takes place in an
environment that affords both challenges and opportunities. To understand
Homo occupacio requires addressing all of these levels in interaction with the
qualities of the environment.
In my next life I should like to focus on the study of play because it represents such a rich prototype of occupation, involving all levels of the human
system in interaction with the environment. Play makes an essential contribution to human development and learning (Reilly, 1974) but its significance is
largely unappreciated both by scientists and ordinary people.
In a stimulating work, Lakoff and Johnson (1999) showed that most
abstract concepts used in everyday communication as well as in science and
philosophy are metaphorical, and thus metaphors constitute a primary tool of
thought and language. What is the source of such a pervasive way of thinking?
Through providing overwhelming evidence, these authors showed that
metaphor is embodied. It is grounded in common human body experiences
such as encounters with objects, space, time and movement (Lakoff and Johnson, 1999). For example, human purposes metaphorically are translated into
desired objects, as in I saw an opportunity for success and grabbed it (1999:
53). This metaphor is based on grasping a coveted object (correlating satisfaction with holding a desired physical object).
I see that this work, connecting newly emerging, interdisciplinary cognitive science to everyday experience, underlines the importance of the childs
intense involvement in play and exploratory learning for the development of
thinking and communication skills, although the authors did not discuss such
an implication. It seems to substantiate the significance of the embodied
experience of play and its outcome of learning the rules of objects, people and
motion (Reilly, 1974).
It is stimulating to learn that other metaphors used to describe achieving a
purpose are also derived from occupations. For example, achieving a purpose is
getting something to eat (shes hungry for success), hunting (Im shooting for a promotion), fishing (its time to fish or cut bait) and farming (these are the fruits of
his labour). Thus, embodied experiences of occupation in play and in the real
world influence how human systems learn to think and communicate about
all significant components of life. Lakoff and Johnsons work (1999) showed
the importance of this embodied learning to being able to participate in society, thus supporting the use of play and other occupations as therapy.
Our science needs to address how people set goals, make conscious
choices, define themselves and become responsible for themselves through
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Creating such a challenge in the context of unique personal and environmental differences is the keystone of the knowledge applied in occupational therapy practice.
Concern with how to create an appropriate environmental challenge fostering capability requires that occupational scientists learn much more about
how to structure environments which are user-friendly for all people, including those with impairments. Members of the Independent Living Movement
have urged public policy makers to view disability not as residing in people,
but as a primary deficit in the environment which impairs their capability.
Our study of the environment could support such a perception, fuelling advocacy efforts to create more user-friendly environments around the world.
Values
As an occupational science detective, I need to develop a conceptual map
that will guide my scholarship, leading me to treasures which can contribute
to but not be bound by the immediate demands of practice. How might I seek
such knowledge to strengthen our profession and those it might serve? Here I
look to the traditions and values of occupational therapy to guide my investigation. (This is a good argument for assuring that occupational therapists and
scientists are well socialized into the history of our profession, worldwide.)
Such values as holism, optimism about potential, viewing people with
impairments as part of the mainstream, discovering and enhancing the
healthy aspects of people, understanding the subjective, encouraging selfdirectedness and choice and viewing occupation as being as essential to life as
food and water are a few examples.
Occupational therapists who value holism often practise in a medically
oriented environment that separates the mind from the body, speaking of
physical disability or mental health. This separation often limits the way occupation may be used as therapy and may result in a failure to meet important
human needs (Burnett and Yerxa, 1980). Yet, new knowledge from interdisciplinary cognitive science supports holism (Damasio, 1994; Lakoff and Johnson, 1999). Emotions make an essential contribution to practical reasoning as
it is used in the everyday world of work, play and relationships. Damasio
(1994) proposes that the brain and the rest of the body are an indissociable
organism integrated by interactive biochemical and neural regulatory circuits,
that the human organism interacts with the environment as an ensemble (not
as brain alone nor body alone) and that mental phenomena can be understood only in the context of an organism interacting in an environment that
is partially a product of the organisms activity itself.
Disciplines offering relevant knowledge which seem to share some of these
values and therefore fit with our epistemology include evolutionary biology,
anthropology, developmental and social psychology, interdisciplinary cognitive science, management theory, social geography, sociology and philosophy.
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Because the interaction of Homo occupacio and the environment is so complex, it is difficult to omit any scholarly resource. However, I have found the
most gold in those disciplines which fit occupation without inconsistencies
in world view or clashes in values. Although occupational therapists need to
understand pathology as a source of challenge, I do not expect to find fruitful
ideas in disciplines which focus on the pathological or reduce people to physical, deterministic entities such as genes (Dawkins, 1989; Lewontin, 1993).
Cultures
A great opportunity awaits us in developing occupational science on a global
scale. We need to understand how differences and similarities in culture affect
the occupational human and vice versa. At the highest levels, occupation is a
universal phenomenon, but at a cultural level, it may be expressed in unique
ways. For example, if play behaviour is the developmental antecedent of work
behaviour, as Reilly (1969) posited, how does this continuum vary from culture to culture and among subcultures? As a global community of scholars, we
have the opportunity to study commonalities and differences worldwide, freeing ourselves from the danger of viewing occupation too narrowly, through the
distorting lenses of our own culture.
Implications
What are some potential benefits to the occupational therapy profession and
those we serve as a result of the further development of occupational science?
First, this knowledge will enable us to achieve the essence of true professionalism self-definition of our own realm of practice. I believe that such
knowledge will enable occupational therapy practice to achieve its worldwide
potential to contribute to human healthfulness and to do so as an open professional system, adapting to future changing environmental conditions with
new, effective models of practice.
This knowledge, fostering a practice that enables capability and adaptive
skill, will contribute to the life opportunities for people both with and without
impairments. Thus, the creators of public policy and the public at large will
begin to see that impairments need not be equated with incapacity, tragedy or
a life deemed not worth living. Societies that have exterminated people with
impairments have always used that argument (Proctor, 1988). Occupational
science, by contributing new understanding of adaptive skill and how to
develop it, will counter these voices of pessimism with an ethical stance: how
can this life be transmuted into one worth living through occupation which
finds a way to elicit capability?
The promise of occupational science is rich indeed. The gold we discover
through our own scholarly work has the potential to transform not only those
we serve and the environments in which they carry out their daily lives, but
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Lakoff G, Johnson M (1999). Philosophy in the Flesh: The Embodied Mind and its Challenge
to Western Thought. New York: Basic Books.
Lewontin R (1993). Biology as Ideology. New York: Harper Perennial.
Lewontin R (1997). Billions and billions of demons. The New York Review 44(1): 2832.
Lincoln Y, Guba E (1985). Naturalistic Inquiry. Beverly Hills, CA: Sage.
Meyer A (1922, 1977). The philosophy of occupational therapy. Archives of Occupational
Therapy 1: 110; Reprinted in American Journal of Occupational Therapy 31(10): 63942.
Montgomery M (1984). Resources of adaptation for daily living: A classification with therapeutic implications for occupational therapy. Occupational Therapy in Health Care 1: 923.
Mounter C, Ilott I (1997). Occupational science: A journey of discovery in the United Kingdom. Journal of Occupational Science: Australia 4(2): 505.
Pfeiffer D (1999). Clinical commentary: The categorization and control of people with disabilities. Disability and Rehabilitation 21(3): 1067.
Prn I (1993). Health and adaptedness. Theoretical Medicine 14: 295303.
Proctor RN (1988). Racial Hygiene: Medicine under the Nazis. Cambridge, MA: Harvard University Press.
Reilly M (1962). Occupational therapy can be one of the great ideas of 20th century medicine.
American Journal of Occupational Therapy 16: 3008.
Reilly M (1969). The educational process. American Journal of Occupational Therapy 23:
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Reilly M (1974). Play as Exploratory Learning. Beverly Hills, CA: Sage.
Vash CL (1981). The Psychology of Disability. Springer Series on Rehabilitation, Volume 1.
New York: Springer.
Vygotsky LS (1978). Mind in Society: The Development of Higher Psychological Processes.
Cambridge, MA: Harvard University Press.
Yerxa EJ (1993). Occupational science: A new source of power for participants in occupational
therapy. Journal of Occupational Science: Australia 1(1): 319.
Yerxa EJ (1994). In search of good ideas for occupational therapy. Scandinavian Journal of
Occupational Therapy 1: 715.
Yerxa EJ, Clark F, Frank G, Jackson J, Parham D, Pierce D, Stein C, Zemke R (1989). Occupational science: The foundation for new models of practice. Occupational Therapy in Health
Care 6(4): 117.
Address correspondence to Elizabeth J. Yerxa, EdD, LHD (Hon) ScD (Hon) OTR, FAOTA,
Route 1, 196 Columbine, Bishop, CA 93514, USA.